Wang Youquan, Li Yanhua, Li Nan, Li Yuting, Li Hongxiang, Zhang Dong
Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, China.
Front Nutr. 2025 May 9;12:1555311. doi: 10.3389/fnut.2025.1555311. eCollection 2025.
Nutritional support is crucial for critically ill patients. Recent clinical studies suggest that both overfeeding during the acute phase of critical illness and overly conservative or delayed nutritional therapy can pose significant risks. Given substantial individual variability among critically ill patients, it is challenging to prescribe universally applicable and objective feeding strategies; Instead, we pointed out which nutritional interventions were harmful. We also summarized the reasons for protective nutrition, and elaborated the advantages of protective nutrition from three perspectives: gastrointestinal protection, nutritional protection and metabolic protection. In particular, it is emphasized that overfeeding will lead to metabolic disorders, such as mitochondrial dysfunction, autophagy inhibition, ketogenic inhibition, hyperglycemia, insulin resistance, etc. These detrimental processes can exacerbate one another, contributing to multiple organ dysfunction syndrome and poorer clinical outcomes. We also propose protective nutrition strategies comparable to lung protective ventilation strategies, which may benefit patients. Vigilant monitoring during nutritional implementation is also paramount, enhancing awareness of adverse events for early diagnosis and intervention to mitigate their harm.
营养支持对重症患者至关重要。近期临床研究表明，在危重症急性期过度喂养以及营养治疗过于保守或延迟均会带来重大风险。鉴于重症患者个体差异很大，制定普遍适用且客观的喂养策略具有挑战性；相反，我们指出了哪些营养干预措施是有害的。我们还总结了保护性营养的原因，并从胃肠保护、营养保护和代谢保护三个角度阐述了保护性营养的优势。特别强调的是，过度喂养会导致代谢紊乱，如线粒体功能障碍、自噬抑制、生酮抑制、高血糖、胰岛素抵抗等。这些有害过程会相互加剧，导致多器官功能障碍综合征并使临床结局更差。我们还提出了与肺保护性通气策略相当的保护性营养策略，这可能使患者受益。营养实施过程中的严密监测也至关重要，提高对不良事件的认识以便早期诊断和干预，从而减轻其危害。
